A Levonorgestrel-releasing Intrauterine System for the Treatment of Abnormal Uterine Bleeding

Objectives: To evaluate the efficacy and safety of an intrauterine system releasing 20μg levonorgestrel per 24 hours in the longterm treatment of heavy menstrual blood loss in women unrelated to intrauterine pathology. Methods: Sixty parous women aged 35-48 years with recurrent menorrhagia participated in this study. Women were followed-up for at least 12 months (12-16 months). The effect on menstrual blood loss was evaluated using a simple visual assessment technique. All women to be included in the study were screened for their clinical suitability for intrauterine device insertion. An intrauterine device releasing levonorgestrel 20 μg/day was inserted in each patient within 5 days of the start of menstrual flow. Women were followed-up at 1, 3, 6, 12 months following insertion of the intrauterine device, for clinical and transvaginal ultrasound examinations. Results: One patient experienced intrauterine device expulsion 1 month after device insertion and one woman was lost to followup after achieving amenorrhea and expressing satisfaction. One year of follow-up has been completed for the remaining 58 women: 8 cases with amenorrhea, 12 with oligomenorrhea, 6 with spottings and 32 patients with regular flow, with a significant reduction in the amount of menstrual blood loss. The levonorgestrel-releasing intrauterine system was well tolerated by all women involved in the study and no systemic hormonal side effects were reported. Conclusion: Our findings indicate that the levonorgestrel-releasing intrauterine system is effective in the significiant reduction of the amount of menstrual blood loss in women with menorrhagia, even in the presence of adenomyosis, intramural and subserosal fibroids and renders surgery unnecessary. In addition, the levonorgestrel-releasing intrauterine system showed a high contraceptive efficacy and a good continuation rate for up to 1 year.